NPI: 1720747272 · GRAND ISLAND, NY 14072 · Dental Clinic/Center · NPI assigned 12/13/2021
| Authorized Official | HENNIGAR, WILLIAM (PRESIDENT) |
| NPI Enumeration Date | 12/13/2021 |
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 14 | $770.45 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1110 | Prophylaxis - adult | 14 | 14 | $770.45 |